Let's ramble!

disinfection

The list of potential areas of contamination in hospitals seems to keep growing, leading us to identify more sources of hospital-acquired infections (HAIs) and making hospital cleaning continuously more complicated. To add to this, researchers are now finding that hospital floors are a significant source of hospital-acquired infections. Every day, hospital and clinic floors are flooded by thousands of people. Shoes soles, wheels from equipment, such as monitors or stretchers and bodily fluids all contribute to the contamination of hospital floors.

It seems so obvious; floors are dirty in general. Hospital floors must be even dirtier. However, as Koganti, et. al. (2016) describes,

“… hospital floors are often heavily contaminated but are not considered an important source for pathogen dissemination because they are rarely touched. However, floors are frequently contacted by objects that are subsequently touched by hands (e.g., shoes, socks, slippers). In addition, it is not uncommon for high-touch objects such as call buttons and blood pressure cuffs to be in contact with the floor.”

(Koganti, et. al. (2016).

In addition to this, shoe soles and wheels on equipment also frequently touch hospital floors. Shoes of healthcare professionals can lead to the spread of infection since these workers are visiting many different patient rooms. Similarly, equipment such as monitors, stretchers or infusion pumps all have wheels which touch the floors of multiple hospital rooms.

Now you might be thinking, ‘but surely hospital floors are routinely cleaned?’ While that is true, researchers are now finding that much of the floor cleaning that is done is relatively ineffective since the bacteria is able to reproduce so quickly. So, what can be done to help reduce the risk of hospital floor contamination?

A good hygiene program for hospital floors, to reduce the risk of contamination

The cleaning and the disinfection of floors are essential elements of an effective hygiene program for hospitals. Regular floor maintenance implies the systematic elimination of hidden bacterias, which can be achieved by using vacuums, mopping and other elimination processes.

A good floor disinfection program consists of using effective disinfectants/detergents and procedures that are notable for reducing the risk of contamination. It is also important that cleaning equipment be properly cleaned and maintained, so that bacteria doesn’t spread when cleaning.

Cleaning hospital floors seems like a daunting task, especially since bacteria has been able to reproduce and spread itself so quickly. Healthcare facilities will need to become more exigent with their floor cleaning programs, if they are going to seriously tackle the threat of hospital-acquired infections.

Antibiotics have been around for almost 100 years now, and have proven to be very effective against fighting harmful bacterias. However, during this time, these bacteria had time to evolve and many of them are now becoming “drug-resistant”, meaning that these bacteria have developed a resistance to antibiotics. There are even some bacteria, known as “superbugs”, that have become resistant to nearly every existing antibiotic. If a person is infected with a “superbug”, this means they cannot seek treatment from antibiotics and will have to rely solely on their immune system to fight the disease. This could result in death by diseases that were once treatable. According to the United Nations World Health Organization, “By 2050, estimates indicate that more people could die from antibiotic resistant infections than those who currently die from cancer” (2016), making drug-resistant bacteria one of the most serious health concerns that we face.

Source: Wikimedia Commons

So if antibiotics are becoming ineffective, then what can be done? Researchers are now turning towards a “good virus” called a “bacteriophage”, or simply phage, that kills bacteria, which was previously overlooked by researchers and scientists.

Phages: The Virus that kills drug-resistant superbugs

First of all, what is a phage? Simply put, phages are viruses that infect specific bacteria (Motherboard, Vice). This means that bacteriophages do not infect human or animal cells. There are more phages on earth than any other living specimen, and they can be found almost anywhere. There are also many different kinds of phages, and each phage does not fight the same bacteria.

Phages kill bacteria by binding themselves to the membrane of the bacteria when they come in contact with it and then releasing an enzyme that drills a hole in the bacteria cell. The phage then injects its own DNA into the cell and reproduces more phages inside of it. This causes the bacteria cell to explode (Motherboard, Vice). Phages can therefore be used as a natural alternative to antibiotics, and may prove to be even more effective.

Source: Wikimedia Commons

In the early 1900s, phages were studied by many researchers and scientists all over the world, however, after the invention of antibiotics, Western countries became less interested in phages and any research about the viruses were put to a halt. The Soviet Union, on the other hand, kept investing in phage research and Russia, Georgia and Poland are among the only countries that use phage therapy today as a bacteria-fighting technique. Research scientist Benjamin Chan (Yale University) explains that the United States has been “hesitant to use bacteriophages because they’re a virus.” However, he goes on to explain that there are many types of viruses and virus does not always mean that there is a disease involved.

Will phages replace antibiotics in the future?

Maybe. It will take some time, as much research still needs to be done by Western countries. Many science researchers believe that they will begin to be used out of desperation. One thing is for sure though: our current antibiotics will no longer be a sustainable option and we need to find another alternative and fast!

Hospital-acquired infections are a serious threat in healthcare facilities today and researchers keep finding new sources of these infections. We know that sources of HAIs include surfaces, high-touch objects, hands and medical devices, but did you know that these infections can also occur due to the water and plumbing systems in healthcare facilities?

Source: Public Domain Pictures

According to Infection Control Today (2018), “Potable and utility water systems in healthcare settings are reservoirs and vectors of Hospital-acquired infections, resulting in pneumonias, bacteremias, skin infections, surgical site infections, eye infections and others.”

Hospitals are major users of potable water, whether it be for drinking, bathing, hand-washing or rinsing medical devices. It is therefore important that healthcare facilities realize that the water entering their facilities is not considered sterile.

Why is the water in plumbing systems infected? The design of and water use patterns in premise plumbing creates biofilms, which provide shelter and food for harmful bacterias. According to Infection Control Today (2018), “Biofilms in premise plumbing systems are complex ecosystems, and it is within these biofilms that bacteria, fungi and amoeba find the food, water and shelter they need.” Many bacteria develop in the biofilms, such as Legionella, Ancinetobacter aumanniii, Aspergillus flavus, etc.

Legionella – what is it and how does it affect patients in a healthcare setting?

Legionella colonies

Source: Wikimedia Commons

Legionella is one example of a bacteria that is found naturally in water. This bacteria is known for causing Legionnaires’ disease: a severe form of pneumonia. This disease is one of the most significant waterborne infections. Legionnaires normally has a mortality rate of only 10%, however, if acquired in a hospital, this rate goes up to anywhere between 25-50% (Infection Control Today, 2018)! Hospitals experience the highest number of outbreaks of Legionnaires disease (compared to other types of buildings) due to having a large number of patients with weakened immune systems or that have chronic diseases. It is important to note that the majority of Legionnaires cases in hospitals are due to the drinking water system.

How to reduce the risk of wHAIs: education and water management programs

So now that we are aware of waterborne hospital acquired infections (wHAIs), is there a way to reduce the risk that potable water poses to healthcare facilities? Infection Control Today (2018) suggests both education and water management programs as possible solutions to reducing the wHAI risk. Firstly, through education, it is important that healthcare workers know that potable water does carry bacteria and does cause an increase in HAIs. Second, once this idea of water carrying bacteria is understood, it will be important to implement water management programs. There can be no standardized water management programs, as all facilities differ in factors such as age of establishment and system, overall design of plumbing system, populations served, etc. Some hospitals have already tried different methods of water disinfection. Examples of these methods used to reduce risk include the use of sterile water in high-risk patient areas, engineering controls and point-of-use water filters.

To summarize, healthcare facilities must realize the risk that water and plumbing systems pose to their patients and employees. Hospital-acquired infections are one of the leading causes of death in North America and it is therefore crucial that hospitals take action against any source that could spread these infections. Education and water management programs are the best ways to help reduce the risk of wHAIs, according to Infection Control Today (2018).

Hygiene and cleanliness are already monitored closely in hospitals and healthcare facilities. Hand sanitation is a crucial hygiene practice for both medical professionals’ well-being, as well as their patients. However, according to TrendHunter (2014), hand hygiene compliance in US hospitals is only achieved 50% of the time. And this is only an example of hand hygiene in the US. Studies would probably show similar, if not worse, percentages in countries across the globe. That is why Biovigil invented a medical hygiene monitoring badge.

Source: Pixabay

The Biovigil monitoring badge is specifically made for hand sanitation. The badge can be clipped on to a scrub or lab coat. It reminds healthcare workers to clean their hands when they leave or enter a patient’s room. It also works by telling either healthcare professionals or patients if their hands have been properly sanitized by turning green when the worker places their hand over the monitor. The badge also collects data on hand sanitation and sends it to be analyzed. While these badges are not heavily used yet, they could prove to be very efficient in eliminating the spread of hospital-aqcuired infections.

It is not, then, unreasonable to ask what other sort of technology could be developed in order to better monitor hygiene and sanitation in healthcare facilities. With the technological resources we have today, it is highly possible to create new products such as this. For now, most hygiene monitoring technologies revolve around hand sanitation. But as we’ve seen in other posts, there are way more sources of contamination and spread of bacteria than just hands; hospital bed mattresses, marked medical instruments, surface damages on medical equipment, etc. Why not create a technology that monitors the hygiene of these things as well? Similarly to the hand sanitation monitor, there could be monitors for other medical equipments that alert healthcare cleaners to check if they are clean and safe to use.

Preventing and controlling the spread of contamination and infection is of very high importance for healthcare facilities, and it is safe to say that many measures have already been taken in order to reach these goals. However, like many things, there is still much room for improvement moreover when it is about surface damage.

Source: Shaw Air Force Base

Evidently healthcare facilities use a wide variety of equipment, from monitors to surgical instruments to cleaning tools, and over time, this equipment wears down. Sometimes, equipment will break completely and be unusable, however sometimes there will only be a few scratches or other small damage. But what happens when these scratches or other forms of damage become shelters and areas of growth for microorganisms? This is an example of how surface damage may not only impede the prevention of bacteria growth, but also provide the microorganisms with a place to grow.

What is surface damage?

According to Infection Control Today, surface damage is defined as:

a quantifiable physical or chemical change from the original manufactured state of an object (surface or device).

While it is recognized that surface damage of medical equipment poses a potential threat in the spread of bacteria in healthcare facilities, there is no standardized method for healthcare workers to determine what is considered surface damage, and at what point the damage is likely to cause the spread of bacteria. In a later blog post, I will discuss the ideal surface damage testing protocol, proposed by Peter Teska et al. in “Infection Control Today.” In this article, the authors discuss ideal methods of avoiding the problems that surface damage presents.

Are your surfaces damaged?

At Lalema, when we talk about hygiene and cleanliness, we offer a wide range of technical and consulting services. Find out more.

As you know, improper and inappropriate use of antibiotics has resulted in bacteria developing resistance mechanisms. In general, we observe a decrease in the effectiveness of antibiotics in fighting multiresistant bacteria. In fact, the antibiotics that were developed between 1940 and 1980 generally had a very specific target, which facilitated the acquisition of resistance mechanisms by bacteria. In addition, the new antibiotics that are marketed are generally similar to existing antibiotics, making resistance acquisition even easier for bacteria. Thus, all the preceding facts suggest the importance of developing new antibiotics displaying novel mechanisms of action.

One of the alternatives is to develop antibiotics targeting the cell membrane of bacteria. Among others, we find the natural antimicrobial peptides that are a class of molecules participating in the immune response of several organisms such as bacteria, plants and mammals [1]. These peptides have the ability to form pores or to induce defects in the cell membrane, which will lead to a disturbance of the electrochemical gradient across the membrane, thus causing cell death (FIG. 1) .

Figure 1: Illustration of the main mechanisms of cationic antimicrobial peptides [3].

Inspired by these natural peptides, many researchers are attempting to develop synthetic antimicrobial peptides that will be both less toxic and pharmacologically viable. On the market, we find daptomycin (Cubicin®) which acts by a mechanism similar to natural antimicrobial peptides [4]. This antibiotic from the lipopeptide family is used for the treatment of infections involving methicillin-resistant Staphylococcus aureus (MRSA). It is interesting to note that, like natural antimicrobial peptides, quaternary ammoniums, which are commonly used in disinfection operations, also destroy bacteria because of their membrane activity [5]. At Lalema, a wide range of quaternary ammonium-based disinfectants are available to meet your needs.

The ever-growing problem of antibiotic resistance is a major health issue and a heavy tax burden on governments. The use of an adequate antibiotic management system, the advent of new technology and better control of the transmission of pathogens (disinfection) are essential tools to reverse the current trend.

For a long time, cleaning has been all about the look; fresh smell and the absence of stains or dirt were the criteria to determine that a place is clean. Today, these criteria are still generally accepted in environments such as offices and classrooms.

It’s common knowledge, however, that microbes (bacteria or viruses) invisible to the human eye represent a risk for spreading infections. Take the example of the influenza virus: it can survive for up to 48 hours on a hard surface!

Without cleaning and disinfection procedures or a quality check procedure, microbes can survive in hospital environments.

Three key elements have to be considered in order to perform an infective risk analysis:

Is the patient carrying a disease agent? Disease agents are classified based on their spreading capacity and their virulence. The choice of a disinfectant will be based on this.

Do the functional activities of a sector represent a risk of spreading infections from the environment? E.g.: food service, offices, Intensive Care, etc.

The intensity of contact is related to the traffic and the surfaces that are more likely to be touched. E.g.: bathroom fittings.

Infective Risk Analysis

Cleaning in hospitals allows reducing risks of infection among patients. This is not the only factor, of course: good personal hygiene habits such as washing hands and the use of protective equipment such as overalls, gloves, masks, or protective glasses are also important elements.

For this reason, interventions must be well coordinated in order to have a good surface maintenance plan. The manager of hygiene and cleanliness should therefore take into account:

The type of place associated to the level of risk

The tasks to perform

The required cleaning frequency

If well applied, a detailed estimate allows validating the cleaning performance.

Balance of microorganisms. This approach is based on the competition between good and bad microbes. The presence of good microbes guarantees less space for bad microbes to grow (e.g.: living environments)

The Cleaning Staff: key to success

The hygiene and cleanliness staff represents a key element in the fight against infections in hospital environments. Often little valued, their role in the global strategy of surface cleaning is extremely important.

The hygiene that comes from the work of the cleaning staff requires a high performance level. In order to reach that, the executing staff and the managers need to master all the different elements representing this profession.

Cleaning products and equipment are undeniably crucial in order to ensure performance during the environment asepsis of any establishment. Therefore, it is important to associate the day-to-day actions of the cleaning staff with a range of products and equipment that favor the quality of their performance.

Since several years, partly due to the devotion and the involvement of many members in the healthcare system, we take into consideration new factors:

Provincial training

Establishment of an AEP hygiene and cleanliness in healthcare environments of 630 hours now offered by many school boards

Provincial day of hygiene and cleanliness

Etc.

Having said this, the hygiene and cleanliness staff deserves our deepest gratitude. Thank you so much!

Work Organization

How can proper work organization contribute to the cleanliness of a hospital? How to be in the right place with the right equipment? Here are the questions we are going to answer in this post of the Cleaning in Hospitals series.

Evaluation of production needs

First, we need to assess the needs in hygiene and cleanliness. In order to do this, a standard evaluation is preferable but it needs to be adjusted based on the type of place, units, and traffic.

It is during the evaluation of needs that the hygiene and cleanliness estimate (see Cleaning in Hospitals part 2) is going to be determined. All daily, weekly, monthly, and annual tasks have to be considered.

Usually, the results are presented by production yields (square meters/hour) or FTE (Full Time Equivalent).

How to reduce time waste

How to measure productivity in a context where an important aspect of the task is moving? Actually, hygiene and cleanliness departments are almost always in the basement, whereas most of their work happens on the floors!

We increase productivity by reducing traveling.

It is for this reason that the cleaning cart needs to be as complete as possible and the water sources or janitor’s closets well stocked with supplies (i.e.: paper products or waste bags), equipment, and sanitary products.

Moreover, it is important to remember that a good entrance carpet can greatly reduce dirt.

Have a successful day!

Here are a few hints on how to have a successful day:

Establish a sequence of actions to perform in a day/week/month

Define a sequential order of rooms

Integrate linked and periodical tasks (monthly)

Make sure to have time gaps to focus on periodical tasks (dusting of high surfaces, polishing, etc.)

Minimize traveling

Work by space and not by task

Distribute tasks equitably

One look is worth a thousand words: choose a colorful plan together with some graphics instead of a list of tasks on a word file!

Want to know more?

Look this free webinar from my collegue Remi:

Need help?

Don’t hesitate to call 514.645.2753 or subscribe to one of our training seminars. I really hope that you liked this post!

One can not stop the progress. The discovery of an enzyme capable of preventing the production of a biofilm, this polymeric protective layer produced by bacteria that prevents antibiotics and surface disinfectants from functioning well, could ultimately revolutionize the fight against nosocomial infections.

We demonstrate that glycoside hydrolases derived from the opportunistic fungus Aspergillus fumigatus and Gram-negative bacterium Pseudomonas aeruginosa can be exploited to disrupt preformed fungal biofilms and reduce virulence.

What is a biofilm?

My colleague Rémi Charlebois described biofilms as follows:

Biofilms found on surfaces are often derived from a complex colony of microorganisms producing polymers that allow them to adhere better to the surface and facilitate colony life. In short, a biofilm is like a city for microbes. Man has learned to tame these biofilms and can use them to treat wastewater or produce certain molecules such as natural plastics. However, the presence of unwanted biofilms could be harmful and can lead to infections.

Biofilms are also found on the skin and medical devices. Thus, according to the article of Le Devoir:

Biofilms, a highly sticky matrix of proteins and sugar polymers made by bacteria to protect themselves, are attached to the skin, mucous membranes or the surface of biomedical materials, including catheters, tubing, heart valves and other prostheses Which become preferred entry points for infection.

In the same article, Dr. Sheppard quotes:

Biofilms are produced by molecules that defend against our immune system or against antibiotics with this shell that is 1000 times more resistant than the organisms that produce and proliferate in these biofilms.

An enzyme that acts as a “destructive machine” for biofilms

In short, the enzyme discovered was modified to destroy the biofilms instead of forming them. This is a new strategy that can reduce nosocomial infections in healthcare centers.

Disinfection and ecology

Disinfection and ecology are two words that we do not tend to associate. Indeed, disinfectants are often based on principles with an unpleasant toxicoecological profile. UL Environment developed a standard for environmentally friendly disinfectant that meets the UL Environment 2794 standard, formerly EcoLogo DCC-166.

But what is an ecological disinfectant?

It is a disinfectant with a minimal risk to the environment. Specifically, it is a product containing no carcinogen or phosphates, which is also low in VOC, non-toxic and readily biodegradable.

Is it as effective as an environmental disinfectant?

For example, we do have a Ecologo certified disinfectant called Eko-Quat. This particular disinfectant is recognized as effective against 20 microorganisms. In particular, against pathogens of importance such as vancomycin-resistant Enterococci, Escherichia coli O157: H7, Listeria monocytogenes and Methicillin-resistant Staphylococcus aureus (MRSA). It goes without saying that this disinfectant is as effective as non-ecological disinfectants based on the same technology. Indeed, our disinfectant has a DIN: 02423391.

Who should use this type of disinfectants?

These disinfectants are ideal for retirement homes, veterinary clinics or hospitals. In short, they are designed for all and allows to disinfect in a responsible way toward the environment.

Why use it?

It is recognized that quaternary ammonium compounds have high efficiency and broad antimicrobial spectrum. Also, did you know that quaternary ammoniums are rather effective in neutralizing odors? Yes, although it is not a feature often discussed quaternary ammoniums, they are very good to neutralize several unpleasant odors.

Biofilms are everywhere

Well hidden or sometimes visible, always disgusting, biofilms, as so well described by my colleague Rémi Charlebois, are defined as follows:

Biofilm is an aggregation of microbial cells, surrounded by a protective layer of extracellular polymeric matrix, which attaches itself to any surface found in the hospital environment and becomes a source of contamination. Formation of complex, multicellular communities by microorganisms is a natural phenomenon which helps bacteria or fungi to survive environmental stress such as cleaning and disinfection.

Warning: Graphic Content Ahead

A Biofilm looks like this:

Kitchen Drain

Source: http://www.biofilm.montana.edu/content/household-biofilms

Sink strainer

Source: http://www.biofilm.montana.edu/content/household-biofilms

Showerhead

Source: http://www.biofilm.montana.edu/content/household-biofilms

Toilet Bowl

Source: http://www.biofilm.montana.edu/content/household-biofilms

How to remove biofilms

Here are 3 methods to eliminate biofilm:

Replace equipment

This mehode is somewhat drastic, probably very expensive certainly mostly impractical. Some industries still proceed that way in 2016. I must say that in some cases it may be the only and best solution. For example pipe sections, filters, etc.

Strong acids and bases

Hydrochloric or Peracetic acids or strong bases such as caustic are sometimes used alternatively. However, corrosivity and danger of these chemicals can damage surfaces, individual protection equipment, storage and handling can also be a challenge . Furthermore, there is always the workplace hazards.

When it comes to cleanliness, some people are mixing technical terms leading to ambiguity. It is like mixing chemicals together: That is not a good idea! To keep it simple, we’ll just give three useful definitions.

Deteriorated surfaces

A deteriorated surface shows wear off sign often caused by time or misuse.

Deterioration is one of three elements of impairment of property, the others being functional obsolescence (or obsolescence) and economic obsolescence.

Safe surfaces

Safe surface means that it is safe to health. Such surface is healthy or good for health often because of risk management. In the food industry, this is why we often refer to it as food safety.
Safe is also synonymous to hygienic !

Disinfected surfaces

Disinfection is a voluntary momentary removal operation of certain bacteria (if it comes to “all germs” we refer more to sterilization), so as to stop or prevent infection or the risk of infection or superinfection by pathogenic or undesirable microorganisms or viruses.

For example:

To sanitize a surface eliminates 99.9% of microorganisms (This is a 1,000 X reduction)

To disinfect a surface removes 99.999% of microorganisms (This is a 100,000 X reduction)

To sterilize a surface or instrument removes 99.9999% of microorganisms (This is a 1,000,000 X reduction)

Obviously, “momentarily” is a key fator because the surface will be contaminated again as soon a a contaminant will enter in contact with the it. That’s why some disinfectants have a residual effect that prolongs the action of disinfectant for a certain time.

How to obtain a more effective disinfection with Certiklör?

What is Certiklör? The name of a new chemical? A new government certification?

None of the above! Simply put, Certiklör technology is the insurance for you, your patients and all Canadians to achieve a better, more efficient and high quality disinfection. Certiklör is a proprietary technology developed by Lalema for you. This technology ensures that you have in the bottle, an effective stabilized hypochlorite, and here to stay!

Stabilized hypochlorite?

Yes, yes! Let me explain. The hypochlorite that is found in bleach for example, flies away usually at a fast rate of more than 1% per month. This means that after 12 months, there will remain only small amounts of the active ingredient: the hypochlorite found in bleach! Imagine how fast this bleach goes away when it’s on the surface to be disinfected in the open air when it does so quickly when, in a closed container!

The difference with our Certiklör stabilized hypochlorite?

The name says it all: stabilized hypochlorite!

Our multidisciplinary team of skilled scientists took 2 years to stabilize the hypochlorite solution. What is the secret? I’m afraid that’s like a little like the Caramilk’s secret! All I can say is that the ingredients that uses this technology have been carefully selected and expertly designed to give hypochlorite increased stability.
And who says stabilized hypochlorite, says better disinfection, less smell and increased cleaning!

How to know if a product uses Certiklör stabilized hypochloritetechnology?

Now, how can you determine which Lalema products use this technology ? Easy! Look at the product label! For now, look at Ali-Flex RTU and Ali-Flex LF.
So if you care about your health, life quality and efficiency at work, think Certiklör stabilized hypochlorite!

The Next Big Thing in Disinfection: Biofilm

Have you ever wondered what are the main factors affecting the efficacy of disinfection and sterilization in the healthcare facility? U.S. Centers for Disease Control and Prevention lists seven major causes of microbiological persistence on surfaces:

Number of microorganisms

Microbial resistance to biocides

Concentration and Potency of Disinfectants

Duration of Exposure

Chemical and Physical Factors

Presence of Organic or Inorganic Matter

Biofilms

For many experienced healthcare professionals, these factors are well known and often well dealt with. However, did you know the difference between soil (organic and inorganic matter) and biofilm? They both can significantly lower the efficacy of disinfection, but the biofilm is much harder to remove and control.

What is biofilm and how does it form?

Biofilm is an aggregation of microbial cells, surrounded by a protective layer of extracellular polymeric matrix, which attaches itself to any surface found in the hospital environment and becomes a source of contamination. Formation of complex, multicellular communities by microorganisms is a natural phenomenon which helps bacteria or fungi to survive environmental stress such as cleaning and disinfection.

Many pathogens require a presence of conditioning layer made from organic soil to settle and start extracellular matrix synthesis. But there are bacteria which don’t really need much help to start a biofilm community. When pathogens settle down and surround themselves in an extracellular polymeric substance (EPS), they are much harder to kill.

It has been reported that bacteria found in biofilm can be up to 1,000 times more resistant to biocides than their planktonic counterparts.

How to outsmart and fight biofilm?

Despite biofilms’ rigid structure and resistance mechanisms, biofilm cells can still be outsmarted. Since EPS is the ultimate protective barrier and communication route for pathogens, the control of biofilm should start with disruption of the EPS itself, followed by an application of a biocide.

MERS-CoV: Practical Tips for Disinfection

The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is slowly spreading through the Middle East and Asia. Transmission, so far, seems to happen when a close contact with an infected individual occurs. This type of transmission has led to many healthcare associated infections to this day. As an example, a patient that waited for 2.5 days in a Seoul emergency department, end up transmitting the disease to 55 persons.

So far, the case-fatality rate is around 36 %, which is very high. However, this number may not be representative of a normal population and its kill rate is likely to be overestimated. A bias might exist when looking at the population who acquired the virus in Korea. Of the 171 cases, many had underlying medical conditions and have a median age of 55.

Official recommendations

CDC and Health Canada issued a few recommendations on infection control and prevention so far, and more is likely to be available soon. Regardless of their recommendations few data are available on environmental hygiene and disinfection practice regarding MERS-CoV in healthcare settings. Also, the transmission through the environment is not well known for this virus.

How to disinfect?

Regarding disinfection few information are available. Coronaviruses are non-enveloped virus which makes them more resistant to certain disinfectant. As an example, it is known that a 400 ppm solution of quaternary ammonium compounds is ineffective against those viruses. Sodium hypochlorite at a minimum of 1,000 ppm seems to be sufficient, however a higher concentration would be optimal in healthcare settings. Very few data exist regarding other disinfectant technology.

At this moment, isolation with contact-droplets precaution is advised. In spite of the fact that it was suggested during the SARS outbreak that this type isolation might not be sufficient. Even though these two viruses are similar, we must remember that many differences exist. Thus we must be careful with extrapolation of data.

A nurse from the Texas Health Presbyterian Hospital, where a patient was treated for Ebola, contracted the disease. This is the first case of Ebola transmission in North America. Although the authorities are reassuring, the question arises in hospitals: Are protocols in place really effective?

The nurse in question, Ms. Nina Pham wore protective equipment as directed by the hospital. Indeed, she claims to have followed protocol at all times and she is unable to identify how she could have contracted the virus. It is assumed that methods of environmental control were in place so the room was disinfected daily with sodium hypochlorite as prescribed.

A breach of protocol?

The director of the CDC (Center for Disease Control), Dr. Thomas R. Frieden believes that treatment protocols were not followed to the letter “Clearly there was a breach in protocol. We have the ability to prevent the spread of Ebola by caring safely for patients.”

CDCs are investigating in order to identify how Ms. Pham may have acquired the infection. Protocols are of course being examined. They would be sufficient to protect healthcare workers from infection by the virus if followed properly. Nevertheless, removing the protective equipment is always pointed out as a critical step. In Europe, another investigation is under way to understand how a Spanish nurse found herself in the same situation.

No reported case in Quebec, yet

The Ministère de la Santé et des Services sociaux in collaboration with the Institut nationale de santé publique du Québec has issued recommendations in case of an outbreak. It is important that each healthcare center that can receive a potentially infectious patient put in place appropriate precautionary measures. Thus, it is important to have the required equipment for this type of care.

At Lalema, we can help you by providing all the necessary protective equipment and disinfectant ! For any special needs, please contact us.

The Ebola outbreak in West Africa is slowly becoming an epidemic that is spreading beyond Africa. Although the risk of transmission is relatively low, it is the largest ever recorded outbreak of Ebola. WHO, CDC and other NGOs have declared a state of emergency and fight tirelessly to limit the outbreak.

Importance of hygiene when it comes to Ebola

The debate today is polarized on the ethical use of experimental drugs. However, few media state of the propagation modes and the importance of hygiene against this virus. Although transmission is being achieved mainly by direct contact between two people, contaminated objects and surfaces can present a risk that is hard to assessed. Thus, the CDC and WHO suggest that objects in direct contact with the patient must be decontaminated properly and that medical or objects contaminated with body fluids must be incinerated.

Stabilized Sodium Hypochlorite

All well and good, but what product can be used to disinfect appropriately? Ebola Virus Outbreak Guidelines written by members of the Ministry of Public Health of Gabon suggest the use of sodium hypochlorite.

We do not always know the microbial threats we face, but if in doubt use a disinfectant caliber is required.

How can proper work organization contribute to the cleanliness of a hospital? How to be in the right place with the right equipment? Here are the questions we are going to answer in this post of the Cleaning in Hospitals series.

Evaluation of production needs

First, we need to assess the needs in hygiene and cleanliness. In order to do this, a standard evaluation is preferable but it needs to be adjusted based on the type of place, units, and traffic.

It is during the evaluation of needs that the hygiene and cleanliness estimate (see Cleaning in Hospitals part 2) is going to be determined. All daily, weekly, monthly, and annual tasks have to be considered.

Usually, the results are presented by production yields (square meters/hour) or FTE (Full Time Equivalent).

How to reduce time waste

How to measure productivity in a context where an important aspect of the task is moving? Actually, hygiene and cleanliness departments are almost always in the basement, whereas most of their work happens on the floors!

We increase productivity by reducing traveling.

It is for this reason that the cleaning cart needs to be as complete as possible and the water sources or janitor’s closets well stocked with supplies (i.e.: paper products or waste bags), equipment, and sanitary products.
Moreover, it is important to remember that a good entrance carpet can greatly reduce dirt.

Have a successful day!

Here are a few hints on how to have a successful day:

Establish a sequence of actions to perform in a day/week/month

Define a sequential order of rooms

Integrate linked and periodical tasks (monthly)

Make sure to have time gaps to focus on periodical tasks (dusting of high surfaces, polishing, etc.)

Minimize traveling

Work by space and not by task

Distribute tasks equitably

One look is worth a thousand words: choose a colorful plan together with some graphics instead of a list of tasks on a word file!

This is all for this series of posts on Cleaning in Hospitals! Don’t forget that we’re always here to help, don’t hesitate to book an appointment by calling 514.645.2753 or subscribe to one of our training seminars. I really hope that you liked this serie of posts!

The hygiene and cleanliness staff represents a key element in the fight against infections in hospital environments. Often little valued, their role in the global strategy of surface cleaning is extremely important.

The hygiene that comes from the work of the cleaning staff requires a high performance level. In order to reach that, the executing staff and the managers need to master all the different elements representing this profession.

Cleaning products and equipment are undeniably crucial in order to ensure performance during the environment asepsis of any establishment. Therefore, it is important to associate the day-to-day actions of the cleaning staff with a range of products and equipment that favor the quality of their performance.

Since several years, partly due to the devotion and the involvement of many members in the healthcare system, we take into consideration new factors:

Provincial training

Establishment of an AEP hygiene and cleanliness in healthcare environments of 630 hours now offered by many school boards

Provincial day of hygiene and cleanliness

Etc.

Having said this, the hygiene and cleanliness staff deserves our deepest gratitude. Thank you so much!

The next post is going to talk more in detail about one aspect of their profession: work organization.

Cleaning in hospitals allows reducing risks of infection among patients. This is not the only factor, of course: good personal hygiene habits such as washing hands and the use of protective equipment such as overalls, gloves, masks, or protective glasses are also important elements.

For this reason, interventions must be well coordinated in order to have a good surface maintenance plan. The manager of hygiene and cleanliness should therefore take into account:

The type of place associated to the level of risk

The tasks to perform

The required cleaning frequency

If well applied, a detailed estimate allows validating the cleaning performance.

Balance of microorganisms. This approach is based on the competition between good and bad microbes. The presence of good microbes guarantees less space for bad microbes to grow (e.g.: living environments)

For a long time, cleaning has been all about the look; fresh smell and the absence of stains or dirt were the criteria to determine that a place is clean. Today, these criteria are still generally accepted in environments such as offices and classrooms.

It’s common knowledge, however, that microbes (bacteria or viruses) invisible to the human eye represent a risk for spreading infections. Take the example of the influenza virus: it can survive for up to 48 hours on a hard surface!

Without cleaning and disinfection procedures or a quality check procedure, microbes can survive in hospital environments.

Three key elements have to be considered in order to perform an infective risk analysis:

Is the patient carrying a disease agent? Disease agents are classified based on their spreading capacity and their virulence. The choice of a disinfectant will be based on this.

Do the functional activities of a sector represent a risk of spreading infections from the environment? E.g.: food service, offices, Intensive Care, etc.

The intensity of contact is related to the traffic and the surfaces that are more likely to be touched. E.g.: bathroom fittings.

Have you already performed an infective risk analysis? The next post is going to explain how cleaning allows reducing risks of infection among patients.

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